A nurse is receiving a change-of-shift report for a group of assigned clients. The nurse anticipates which of the following activities first in delivering client care using the nursing process?

Set client-centered, measurable and realistic goals.

Critically analyze client data to determine priorities.

Determine effectiveness of interventions.

Collect and organize client data.

Answer and Explanation

The Correct Answer is D

A. Set client-centered, measurable and realistic goals: This occurs during the planning stage, after data collection and analysis.

B. Critically analyze client data to determine priorities: This step happens after data collection during the diagnosis phase.

C. Determine effectiveness of interventions: This is part of the evaluation stage, which comes after planning and implementation.

D. Collect and organize client data: This is the first step in the nursing process, where the nurse gathers comprehensive information about the client's physical, psychological, sociocultural, developmental, and spiritual needs.

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Correct Answer is A

Explanation

A. Ask the client to read a Snellen chart: Cranial nerve II (Optic nerve) is responsible for vision. Assessing the client's ability to read a Snellen chart tests visual acuity, which is a function of cranial nerve II.

B. Listen to the client's speech: This assesses cranial nerves V (Trigeminal) and VII (Facial), which are involved in speech and facial sensation.

C. Ask the client to clench his teeth: This assesses cranial nerve V (Trigeminal), which controls jaw movement and sensation.

D. Ask the client to identify scented aromas: This assesses cranial nerve I (Olfactory), which is responsible for the sense of smell.

A. Concrete operational B. Sensorimotor C. Formal operational D. Preoperational

Correct Answer is B

Explanation

A. Concrete operational: This stage (7 to 11 years) is characterized by logical thinking about concrete events.

B. Sensorimotor: This stage (birth to about 2 years) is when infants learn about the world through their senses and actions. Object permanence—the understanding that objects continue to exist even when they cannot be seen, heard, or touched—develops in this stage.

C. Formal operational: This stage (12 years and up) involves abstract and moral reasoning.

D. Preoperational: This stage (2 to 7 years) is when children begin to engage in symbolic play and learn to manipulate symbols, but they don’t yet understand concrete logic.

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A nurse is receiving a change-of-shift report for a group of assigned clients. The nurse anticipates which of the following activities first in delivering client care using the nursing process?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client's cranial nerves. Which of the following methods should the nurse use to assess cranial nerve II?

Correct Answer is A

Explanation

A nurse is teaching a class about Piaget's stages of cognitive development. The nurse should instruct that object permanence develops during which of the following stages?

Correct Answer is B

Explanation

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